Termination of Pediatric Resuscitation – the Elephant in the Room, PART 2

The acuity of the pediatric emergency department at St. Louis Children’s Hospital is the highest I have encountered. While this has been an excellent experience for me as a junior faculty member, those instances requiring me to terminate resuscitation in a child have been difficult clinically and emotionally – driving me to analyze the process and sit with the “elephant in the room” previously introduced in the PEMNetwork’s Termination of Pediatric Resuscitation PART 1.

I cared for Child A that sustained a gun shot wound to the head. The child arrived to my care within 30 min of the injury and our resuscitation with trauma and neurosurgery went smoothly in the emergency department, in the operating room, and in the PICU. That child walked out of the hospital a month later. Shortly thereafter, I cared for Child B who also sustained a gun shot wound to the head. That child arrived to my care within 4 hours of injury and in cardiac arrest. Initial resuscitation provided a return of spontaneous circulation, but that child ultimately died in the emergency department after prolonged efforts. While there were clear differences in the presentation and course of resuscitation for Child A and Child B despite similar injuries, they had vastly different outcomes. My positive experience with Child A made it even more emotionally difficult to ultimately terminate resuscitation in Child B.

At this point, I reviewed the course with the trauma team and asked our trauma attending what he thought of terminating resuscitation at that point – he agreed that the resuscitation was no longer effective.

I told our team we were stopping resuscitation efforts and noted the time of death. We ensured that Child B was clean, without ET tube/stickers/lines in place, while the family grieved and I explained the course of events to them.